三尖瓣下移矫治术中同期处理B型预激综合征的疗效观察  

Clinical Efficacy of One-stage Surgery for Type B Wolff-Parkinson-White Syndrome Combined With Ebstein’s Anomaly

作　　者：孙寒松[1] 李彬[1] SUN Hansong;LI Bin(Department of Cardiac Surgery,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心外科

出　　处：《中国循环杂志》2019年第12期1215-1218,共4页Chinese Circulation Journal

摘　　要：目的 :本研究旨在观察三尖瓣下移畸形矫治术的患者同期处理B型预激综合征的近中期效果。方法:选取2006年03月至2016年03月期间,在我们中心行三尖瓣下移畸形矫治术的同期处理B型预激综合征的患者8例,中位年龄22岁(8~44岁)。建立体外循环后,不需要术中标测靶点,于并行体外循环或者心脏停跳下行外科直视单极笔射频消融或外科切缝的方式消除预激旁道。治疗的部位在三尖瓣瓣环外2 mm处,从三尖瓣前叶下移部分内侧开始,远端不超过冠状静脉窦。通过术中或术后心电图对手术效果进行评价。结果:8例患者术中外科切缝5例,外科直视射频消融3例;中位随访时间为25.5个月(3~129个月)。术后早期及随访过程中无死亡病例。术中心电图提示室上性心动过速终止,预激波消失。随访期间患者未再发生室上性心动过速事件,心电图检查未再发现预激波出现。结论:针对需行三尖瓣下移畸形矫治术并合并B型预激综合征的患者,可在术中无标测的情况下通过外科直视射频消融或外科切缝的方式消除预激旁道,并可以获得良好的近中期效果。Objectives: This study was undertaken to review the the early and middle term outcome of surgical treatments of patients with type B Wolff-Parkinson-White syndrome combined with Ebstein’s anomaly without intraoperative electro-physiologic mapping. Methods: From March 2006 to March 2016, 8 patients, who underwent one-stage surgery approach for type B WolffParkinson-White syndrome combined with Ebstein’s anomaly, were included in this study. Median age at operation was 22 years(range 8 to 44 years), and 5 patients(62.5%) were male. When cardiopulmonary bypass was instituted, atrioventricular accessory conduction pathways were abolished through surgical ablation or surgical division before or after administration of cardioplegia without intraoperative electrophysiologic mapping. The range of surgical ablation or surgical division was from the internal part of displaced anterior leaflet to the coronary sinus. Electrocardiographic studies before, during and after operation were evaluated. Results: Median follow-up time was 25.5(3-129) months. All patients are alive. The intraoperative or postoperative electrocardiogram showed that supraventricular tachyarrhythmia was terminated and the delta waves disappeared post procedure. The episodes of supraventricular tachycardia disappeared and delta waves were not evidenced on the electrocardiographic examination during follow-up period. Conclusions: Surgical ablation or surgical division of atrioventricular accessory conduction pathways without intraoperative electrophysiologic mapping is a suitable approach for the treatment of type B Wolff-Parkinson-White syndrome combined with Ebstein’s anomaly. Optimal results were obtained during mid-term follow-up.

关 键 词：先天性心脏病 EBSTEIN畸形 预激综合征 外科切缝 外科直视射频消融 

分 类 号：R541[医药卫生—心血管疾病]